Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2010 Nov 23;56(22):1840-6. doi: 10.1016/j.jacc.2010.03.107.
The aim of the current study was to test the hypothesis that vascular and endothelial functional responses to acute mental stress are abnormal in patients with apical ballooning syndrome (ABS).
Apical ballooning syndrome is a transient cardiomyopathy that occurs predominantly in post-menopausal women and may be triggered by acute mental stress. The mechanism for ABS is unknown.
Reactive hyperemia as a parameter of endothelial function and vascular responses to acute mental stress were measured using peripheral arterial tonometry (PAT) at baseline and following 3 acute mental stress tests in female patients with ABS (n = 12, at least 6 months after being hospitalized or diagnosed with ABS), post-menopausal female controls (n = 12), and female patients with myocardial infarction (MI) (n = 4). Plasma catecholamine levels were measured at baseline and following the 3 mental stress tests.
Reactive hyperemia PAT scores following mental stress were significantly lower in patients with ABS compared with post-menopausal controls (p < 0.05). The PAT scores during mental stress were significantly lower in patients with ABS compared with patients with MI and post-menopausal controls (p < 0.05). There were no differences in PAT scores during acute mental stress in patients with MI versus post-menopausal controls. Furthermore, catecholamine levels were significantly increased in patients with ABS, compared with post-menopausal controls, following acute mental stress testing (p < 0.05).
There is increased vascular reactivity and decreased endothelial function in response to acute mental stress in patients with a prior episode of ABS. The findings implicate vasomotor dysfunction as a potential mechanism involved in the pathogenesis of this unique cardiomyopathy.
本研究旨在验证血管和内皮功能对急性精神应激反应异常的假设，该假设适用于心尖球囊样综合征（ABS）患者。
心尖球囊样综合征是一种短暂性心肌病，主要发生在绝经后妇女中，可能由急性精神应激引发。ABS 的发病机制尚不清楚。
通过外周动脉张力测定法（PAT），在基线水平以及 3 次急性精神应激测试后，测量 ABS 女性患者（n = 12，至少在住院或确诊 ABS 后 6 个月）、绝经后女性对照组（n = 12）和心肌梗死（MI）女性患者（n = 4）的反应性充血作为内皮功能和血管对急性精神应激反应的参数。在基线水平和 3 次精神应激测试后测量血浆儿茶酚胺水平。
与绝经后对照组相比，ABS 患者在精神应激后的反应性充血 PAT 评分明显较低（p < 0.05）。ABS 患者在精神应激期间的 PAT 评分明显低于 MI 患者和绝经后对照组（p < 0.05）。MI 患者与绝经后对照组相比，在急性精神应激期间的 PAT 评分没有差异。此外，与绝经后对照组相比，ABS 患者在急性精神应激测试后儿茶酚胺水平显著升高（p < 0.05）。
在既往 ABS 发作的患者中，对急性精神应激的血管反应性增加和内皮功能降低。这些发现表明血管舒缩功能障碍可能是这种独特心肌病发病机制的一个潜在机制。
